Healthcare Provider Details

I. General information

NPI: 1538377536
Provider Name (Legal Business Name): ALEC GRAHAM M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 06/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 ALVARADO RD SUITE 408-A
LA MESA CA
91941-3616
US

IV. Provider business mailing address

7777 ALVARADO RD SUITE 408-A
LA MESA CA
91941-3616
US

V. Phone/Fax

Practice location:
  • Phone: 619-713-0017
  • Fax:
Mailing address:
  • Phone: 619-713-0017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number7232
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: